The use of crossing catheters in the recanalization of below-the-knee chronic total occlusions in patients with critical limb ischemia

Background: This study investigates the procedural success of the use of a hydrophilic crossing catheter in the recanalization of below-the-knee artery chronic total occlusions in patients with critical limb ischemia. Methods: We retrospectively identified below-the knee chronic total occlusion interventions in 30 patients performed between March 2013 and July 2017 in our institute. The inclusion criteria were critical limb ischemia (Rutherford Class 4 or greater) and occlusion of at least one tibial vessel with revascularization performed with the use of a crossing catheter. Primary technical success was defined as placement of a guide wire in the true lumen, past the distal chronic total occlusions cap. Results: Thirty patients underwent 34 procedures, in which 41 lesions were treated with the use of crossing catheters. Nineteen anterior tibial arteries, 18 posterior tibial arteries, and four peroneal arteries were treated. Mean length was 110.2 +/- 36 mm and 20 lesions (48.8%) were severely calcified. The primary technical success rate was 80.5%. Recanalization was achieved with a guide wire and crossing catheter in 25 lesions (76%) and with the crossing catheter alone in eight cases (24%). Conclusion: The use of a crossing catheter showed a high rate of technical and procedural success in infrapopliteal chronic total occlusions without significant complications.